Doctor vs. Nurse Practitioner/Dr.'s Assistant

Do you feel it’s fair to be charged the same amount for a visit with the Nurse Practitioner as you do for a visit with the doctor?

In general, yes. Nurse Practitioners and Physicians Assistants are perfectly well trained in the stuff that they are authorized to do and they may even be better at it than the M.D. in the practice. I look at it as paying the practice for services. It doesn’t really matter which qualified person does it. OTOH, I would expect for the M.D. to be called in ASAP if the others think the condition requires a different level of expertise. I have never seen anything that suggests PA and NP’s give substandard levels of care and my personal experience suggests they are at least as good for what they do.

Let’s see…the last time I had a Nurse Practitioner, she diagnosed me as having a fairly nasty, incurable disease, put me on some pretty heavy-duty medication that could have permanently affected my body, and sent me home to deal with fear, depression, and all sorts of other emotional things. When the actual doctor finally saw me a few weeks later, she dismissed the symptoms as a totally benign, totally common, totally innocent condition, not the life-changing one I thought I had.

I love nurses in general, and have many friends in the profession, but an NP will not be treating me in the future unless the doctor comes and checks her work.

I can’t remember the last time that I saw a doctor other than my eye doctor. I have had universally poor experiences with nurse practitioners. I tell them that going to the doctor gives me a panic attack because I was molested, they say they understand and then three minutes later it’s “Why is your blood pressure so high?” They will never believe me that it is the panic attack, which I am clearly having, no it has to be some horrible condition even though my standard blood pressure when I donate blood is like 105/70, which I’ve had them tell me flat out I was lying about. Not that I have any proof that doctors are any better, but I doubt they could be much worse.

Every time I’ve seen the FNP or the PA, they’ve checked with the doctor for anything serious. To some extent I feel I am getting a similar level of supervision of my case (if needed); it’s just that the face I am seeing is different. I don’t mind the same co-pay (which in either case is reasonable) so I suppose it’s up to my insurance carrier to decide whether or not they think it’s right to pay the same amount for either. If it was my own money, I wouldn’t mind paying the same rate. I feel that the level of care is comparable, and I know that if I have any doubts or questions related to that visit I could see a doctor on the spot, and not have to make a second appointment.

I guess I am biased–I have always had excellent care from the FNPs. I often request the FNPs because I like their approach and outlook, and I like the level of care they give. Plus there are (apparently) enough patients who insist on a doctor that the FNPs generally easier to get in to see. My experience with my doctor’s PA has been iffier, but not so much that I avoid her (or expect to pay less when I see her).

Incidentally, my practice is a training site for local med students doing their family practice rotation. Sometimes a med student is the face I see (they always ask first; I always say “fine”). Of course, this is always followed up by a check with the doctor (and these are much more closely supervised than an FNP visit). I pay the same rate for those visits too. They’re pretty interesting, IMHO.

Yes, especially for GP stuff. But usually they aren’t Specialists, who can command more.

My CRNP charges substantially less per visit ($60 vs. $110) than the doctors in the same office. In her case, I think it’s fair, because she doesn’t seem particularly competent. When I first started seeing her and told her my previous doctor had prescribed Provigil for me, she had to look the drug up; she’d never even heard of it. Numerous similar incidents have occured since then, but I keep going back because I don’t have insurance and can’t afford the real doctors.

Hijack–

I wish they change the name from Physician’s Assistant to something else…say “Healer”, or “Healer Tech” or something.

It makes people. especially older people, confuse it with “Doctor’s Assistant”, a semi-skilled worker.

You cannot imagine the “discussions” :rolleyes: :smack: I’ve had with my eldery Father over this.

Endless discussions…

In my experience, Nurse Practitioners are better doctors than the doctors are – they listen more carefully, and generally take more time with you, and seem more interested in giving you an accurate diagnosis. I suppose that’s because they’re cheaper. I’ve never had to pay directly myself, though – it all comes out of insurance.

So to the OP, I agree with Shagnasty – it’s more about the service than about the qualifications.

In my clinic, we charge the same for a visit with a mid-level (the generic term for PAs and NPs) or with a physician. IIRC, there are some payors who won’t pay the same, but most do.

In the case of my clinic, it has nothing to do with being cheaper, and everything to do with my stress level. My job includes managing all the mid-levels, taking care of a busy hospital service, seeing a full slate of outpatients, and taking call every weekday and every third weekend. The mid-levels are there to see outpatients, and that’s it. They are likely to give you more time and energy, because they have more time and energy to give. (And yes, doctors do this to themselves, I admit it.)

It must be my doctor, but although a nurse or tech takes my vitals when I come in, I always see the doctor. I don’t go often, but when I do, she’s the one who sees me. And she’s called me at home to check on me after the fact, sometimes as late as 7:30 at night. She works very hard.

StG

My doctor had a baby and quit a couple years back (she was awesome) and now I have a NP. She is awesome as well. Very nice, understanding, knowledable, caring. Since I go in for my yearly and when I get a sinus infection only, I can’t tell the difference between a NP and a “real” doctor.

I’ve met the “real” doctor left in the office and I don’t like him much. My mom goes to him, and so does grandma.

When I was looking for a new doctor, a coworker recommended a nurse practioner. But I really don’t get it; doctors go to med school for a reason, I’d much rather have the person with considerably more eduction. Besides, I harbor this strange day dream that I go see the doctor and he recognizes my inconsequential rash as the beginning stage of something really rare like, um, South Bolivian Mongoose fever, ala House…

For some things I might agree, but if your case is beyond the NP’s scope of practice and she’s ethical, she’ll send you to someone else.

An NP receives quite a lot of education in most states. She usually has plain ol’ nursing school, a BS in nursing, a master’s in nursing, and then continuing ed or certification in her specialty. What she doesn’t get that doctors do is training in everyone else’s specialty. An OB/Gyn MD will have training in everything from psychiatry to pediatrics to orthopedics before he leaves med school. That’s all well and good, but why does my OB need to know how to perfom a spinal fusion surgery? If I need a spinal fusion, I’ll go to an orthopedic surgeon! An OB/Gyn NP after her nurse training is trained almost exlusively in OB/Gyn for a year, instead of a dozen areas of medicine in 4 years.

I seriously loved my midwife - a Certified Nurse Practioner. But it makes my ears bleed when my family blames her for my daughter’s premature birth, telling me we should have gone to a “real doctor.” What the fuck? It’s not like her snake oil charms gave me a placental infection, people! (And the moment she found out I was bleeding, she sent me straight to the ER and “real doctors”, who never for a second questioned her abilities as a health care professional.)

I think it’s because it’s a chance for them to figure out what they want to do by rotating through a number of specialities. My sister really didn’t know what she wanted to do before she went into rotations. Now she knows. Work less. :wink:

Actually the difference in classroom education between a PA and an MD in Colorado is a few hours of coursework…seriously. Doctors then go on to do an internship and most of them also do a residency in their specialty; PAs don’t have to do the internship/residency. And the PA prerequisites are such that most PA students enter the program with a few years of patient care, in addition to the tough background classes (algebra, biology, etc.), and once licensed they have to take 100 hours of continuing education every two years and pass a relicensing examination. Nurse practitioners may be a little less rigorous but they still have to know what they’re doing.

Being a nurse, I try not to be seen by PAs. They have less education than I did, and they expect me to diagnose myself.
Nurse practitioners are very well educated. Some have PhDs in nursing. I don’t go to them either. Many have never done any bedside nursing. That makes them professional students, not nurses.
IMO, a nursing education doesn’t qualify one to do the work of a physician, any more than it qualifies one to be an administrator.
Please, keep in mind, these are my opinions/prejudices, not meant to influence anyone else.

“Síndrome de la bata blanca” (white coat syndrome, I guess): many people get higher blood pressure when it’s measured by a doctor than a nurse. Or so my SIL was taught in med school. An informal study while she was doing ER rotations as part of her additional GP training showed that it’s a double factor: many people get higher blood pressure when it’s measured by a man than a woman. And a silly amount of people still assume that a woman is a nurse…

In Spain a nurse can’t diagnose, but lots of routine work is handled by them. I’ve got expectations on what can be done by the nurse, what by the nurse aide, what by a GP, what by a specialist; when I’ve gone to private practice the charge was by procedure, it didn’t depend on who did it. All of the above (plus a pharmacist) can measure blood pressure or glucose; I expect the price to be the same. If you’re going to charge me more to have my finger pricked by a cardiologist than by an aide, bring forth the aide.

The best medical care I had was given by a PA. He knew his limitations, but if I needed a boil lanced, warts removed, a Pap smear, or any of a myriad other things done, he could do them. He was a very gentle man, and since his wife had diabetes, he made a habit of learning everything he could about that disease. I benefitted greatly. I sure miss him.

Exactly. I meant why should *I *care if my OB knows spinal fusion surgery. Obviously, I don’t. :wink: